Prioritizing mental health has become an important part of primary health care. It can be confusing to know which service fits your need for behavioral or emotional support, and how to get that service covered as Medicaid and Medicare recipients.

Defining Mental Health Needs

The U.S. Department of Health and Human Services describes several factors that play a role in your mental health. These may be biological or hereditary markers that make you more susceptible to certain conditions. Significant life events may impact your mental health, or a family history of behavioral issues can play a large part in forming your own behaviors.

Symptoms of mental illness can manifest in a variety of behaviors:

  • Dissociation from daily activities, family, friends or interests.
  • Inability to feel common emotional responses.
  • A sense of helplessness or hopelessness.
  • Indulging in substance abuse or dangerous activities.
  • Frequent irritability, moodiness, forgetfulness or worry.
  • Excessive mood swings, intrusive and troubling thoughts and thoughts of harm.
  • Seeing or hearing things that are not real.
  • Feeling physically weak or experiencing pain or aches without a cause.
  • Difficulty maintaining healthy relationships with others.

Common Types of Mental Heath Services

Treatment for mental health needs can take place in the home, at a specialist’s office, as a group or in a hospital setting. The severity of your needs may determine the best treatment plan for your mental health. In some circumstances, more than one type of treatment may be used as behavioral support.

  • Individual therapy. Talk therapy is a common term for this type of treatment, but different therapists may approach this interpersonal style of therapy through specific techniques. These techniques help shape each meeting around a purpose and create wellness goals for the client to achieve between sessions.
  • Group therapy. Many of the techniques used in individual therapy can be used in a group therapy session, but may be specifically designed to help recipients who struggle to socialize appropriately. Group sessions may also help recipients who in need of community-based support systems.
  • Substance abuse rehabilitation. The link between substance abuse and mental health needs creates the need for specialized treatment. This service targets the causes of substance abuse and the effects it has on worsening behavioral needs. Recipients may need full or part-time inpatient care.
  • Medication management. Psychiatric medication is used to treat clinically significant symptoms and may be prescribed in addition to referrals for other behavioral services, such as therapy or hospitalization.
  • Residential treatment. Recipients who experience extremely disruptive behavioral issues or who need to be monitored for safety concerns may be admitted as an inpatient. The length of time depends on the severity of their needs and the evaluation of their psychiatric team.
  • Emergency hospitalization. Recipients who show an immediate risk of harm to themselves or others may be admitted to a behavioral treatment center for emergency care that can last a day or two or more if their needs persist. There, current medications may be evaluated and altered to help them regain function, or they may be prescribed medication and other forms of treatment if they are not currently receiving any.

Mental Health Medicaid Coverage for Medicare Recipients

Both Medicaid and Medicare benefits provide coverage for certain mental health services. Medicare Part B covers outpatient costs while Medicare Part A may take over inpatient charges if you are formally admitted into a hospital or skilled nursing facility. With Medicare, recipients have cost-sharing obligations such as copayments, coinsurance and/or deductible amounts. When Medicare recipients also receive Medicaid benefits, these share-of-cost charges may be paid for by Medicaid, instead. Medicaid may also cover the costs of prescription drugs or extend the number of days covered for inpatient hospital stays. Additionally, Medicaid may provide coverage for therapeutic services that are not eligible under Medicare benefits.

There may be limitations that determine when a recipient can receive a certain type of service or what type of specialist or facility can provide it. Medicaid services are determined by state according to federal regulations, and eligibility is based on Modified Adjusted Gross Income. Check with your Medicare and state Medicaid providers to verify the full scope of services available to you.

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